The alcohol prevention paradox in Ireland: implications for equitable population-level policy
Abstract
Introduction: Although alcohol-attributable mortality risk increases with consumption, harm may be distributed across the wider drinking population. Understanding this distribution is important for designing equitable, population-level prevention strategies. This study examined whether alcohol-attributable deaths in Ireland were concentrated among the highest-consuming drinkers.
Methods: Mean annual alcohol-attributable deaths among residents of Ireland aged ≥15 years during 2022-2024 were estimated using comparative risk assessment. Consumption was estimated from the nationally representative Healthy Ireland Survey 2024 and calibrated to recorded per-capita sales. Mortality data were obtained from the General Mortality Register and relative risks from systematically identified meta-analyses. Drinkers were ranked by calibrated average daily consumption, separately by sex. Deaths and deaths per 100,000 drinkers were estimated for the highest-consuming 10% and remaining 90%.
Results: An estimated 1,420 deaths were alcohol-attributable annually, representing 4.0% of all deaths; 1,096 occurred among men and 324 among women. The highest-consuming 10% had calibrated consumption of at least 72.5 g/day among men and at least 32.5 g/day among women. Among men, the highest-consuming 10% accounted for 448 deaths (41%), while 649 (59%) deaths occurred in the remaining population. Corresponding estimates among women were 149 (46%) and 175 (54%). Mortality rates per 100,000 drinkers were higher in the highest-consuming 10% than in the remaining men (259.4 versus 33.8) and women (83.8 versus 8.7).
Conclusions: Although alcohol-attributable mortality rates were highest among the heaviest 10% of drinkers, more than half of alcohol-attributable deaths occurred in the remaining population. This is consistent with the prevention paradox. Effective and equitable alcohol prevention is therefore likely to require population-level measures alongside targeted support for those at highest risk.
Key messages: • Most alcohol-attributable deaths occurred outside the highest-consuming 10%, supporting population-level prevention alongside targeted support.
• Findings support equitable alcohol policies that reduce harm across the full drinking population, not only among the heaviest drinkers.
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BibTeX
@article{mcdowell2026alcohol,
title = {{The alcohol prevention paradox in Ireland: implications for equitable population-level policy}},
author = {CP McDowell and M Boudou and M O’Neill and L Comber and M Ryan},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1853},
url = {https://doi.org/10.1093/eurpub/ckag169.1853},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The alcohol prevention paradox in Ireland: implications for equitable population-level policy
AU - CP McDowell
AU - M Boudou
AU - M O’Neill
AU - L Comber
AU - M Ryan
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1853
UR - https://doi.org/10.1093/eurpub/ckag169.1853
AB - Introduction: Although alcohol-attributable mortality risk increases with consumption, harm may be distributed across the wider drinking population. Understanding this distribution is important for designing equitable, population-level prevention strategies. This study examined whether alcohol-attributable deaths in Ireland were concentrated among the highest-consuming drinkers. Methods: Mean annual alcohol-attributable deaths among residents of Ireland aged ≥15 years during 2022-2024 were estimated using comparative risk assessment. Consumption was estimated from the nationally representative Healthy Ireland Survey 2024 and calibrated to recorded per-capita sales. Mortality data were obtained from the General Mortality Register and relative risks from systematically identified meta-analyses. Drinkers were ranked by calibrated average daily consumption, separately by sex. Deaths and deaths per 100,000 drinkers were estimated for the highest-consuming 10% and remaining 90%. Results: An estimated 1,420 deaths were alcohol-attributable annually, representing 4.0% of all deaths; 1,096 occurred among men and 324 among women. The highest-consuming 10% had calibrated consumption of at least 72.5 g/day among men and at least 32.5 g/day among women. Among men, the highest-consuming 10% accounted for 448 deaths (41%), while 649 (59%) deaths occurred in the remaining population. Corresponding estimates among women were 149 (46%) and 175 (54%). Mortality rates per 100,000 drinkers were higher in the highest-consuming 10% than in the remaining men (259.4 versus 33.8) and women (83.8 versus 8.7). Conclusions: Although alcohol-attributable mortality rates were highest among the heaviest 10% of drinkers, more than half of alcohol-attributable deaths occurred in the remaining population. This is consistent with the prevention paradox. Effective and equitable alcohol prevention is therefore likely to require population-level measures alongside targeted support for those at highest risk. Key messages: • Most alcohol-attributable deaths occurred outside the highest-consuming 10%, supporting population-level prevention alongside targeted support. • Findings support equitable alcohol policies that reduce harm across the full drinking population, not only among the heaviest drinkers.
SN - 1101-1262
SN - 1464-360X
ER -